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Biomedical subjects

P H Persson

Publications and source records attributed to P H Persson.

18 recordsLinked to original sources
PubMed1979

The intrauterine growth of the biparietal diameter of twins.

A series of 978 repeated ultrasonic measurements of the fetal biparietal diameter (BPD) assessed the growth of 119 twin pairs during the second half of pregnancy. The mean BPD values for each gestational week were close to the mean values for singletons. From the 32nd week, the BPD growth curves for twins deviated from that for singletons. The second twins' growth curve ran consistently below that of the first and fell away more from the 32nd week on. In 80% of the measurements, the first twin (defined as the twin in, or close to, the pelvic inlet) was the one with the largest BPD. The intrapair difference in BPD had no correlation to the intrapair difference in body length, head circumference, or birth weight. In 91 of the 119 twin pairs, zygosity was settled by sex, histological examination of placenta, or blood grouping. The longitudinally compiled BPD growth curves (678 BPD determinations) showed the curve for dizygotic twins consistently running above that of the monozygotic twins. The BPD differences between the first and the second twin remained also within mono- and dizygotic groups of twins.

Birth Weight↗
PubMed1979

Diagnosis and treatment of twin pregnancy.

Early detection is a prerequisite for the active management of twin pregnancy. Detection rate was not, or was only slightly, increased by improved anamnesis or more alert physical examination. General placental lactogen screening selected 95% of the twins but implied a subsequent ultrasonic screening examination of 16% of the pregnant population for the definitive diagnosis. A general screening programme with ultrasound detected 90% of the twin pregnancies (methodological error 1.7%; not participating 8%) in the mid-trimester. Extensive restriction of maternal physical activity from the 29th to the 36th gestational week by bed rest in hospital reduced perinatal mortality to the level of singletons and also decreased the incidence of neurological and mental handicap among the surviving twins. For the supervision of twin pregnancy, urinary estriol estimates predict birth weight rather than fetal distress. Monitoring with repeated ultrasonic biparietal diameter measurements seem limited in value; even large intertwin BPD differences are not indicators of fetal distress in the smallest twin. The decrease of perinatal mortality and morbidity among twins subjected to special antenatal supervision suggests that large gains can be made by early detection and antenatal hospitalization. The earlier finding that impairment of the intrauterine supply line is closely associated with neurological sequelae gives added importance to the reduction of CNS handicap and of growth-retarded fetuses observed during such a programme.

Bed Rest↗
PubMed1979

Determination of myometrial tension during labor by combined microtransducer IUP-rcording and ultrasonic examination of the uterine cavity.

In twelve women, in whom labor was induced by oxytocin infusion, intra-uterine pressure (IUP) was recorded by micro-transducers, and simultaneously the diameter of the uterine cavity was estimated by means of ultrasound. Myometrial tension was calculated according to the law of Laplace. In the ten women who were delivered within eight hours after the start of induction, myometrial tension was clearly higher than in the two in whom induction failed. No technical problems were encountered during the registrations, which in some cases lasted for more than five hours. It is suggested that with the described technique, a more accurate determination of myometrial activity is possible than with the generally used methods for IUP recording. The technique might facilitate evaluation of drug effects on the uterus during labor, and improve the IUP-part of intrapartum clinical monitors.

Adult↗
PubMed1979

On improved outcome of twin pregnancies.

During the past four years, an attempt has been made in Malmö to reduce the frequency of preterm termination of twin pregnancies. For this purpose, the entire pregnant population of this medium-sized city was subjected to general ultrasonic screening in the second trimester. This detected 88 per cent of the twin pregnancies. The screening has a methodological error of 2 per cent. Eightysix of the women with twin pregnancy were subjected to bedrest in hospital for more than two weeks in the second half of gestation. The incidences of twins born with birth weight below 1 500 g and of twins light-for-gestational-age were reduced compared with those a decade earlier. Also the group of twins born before the 37th week decreased, and the perinatal mortality rate fell to the same level as in singleton pregnancies. Early detection of twin pregnancies followed by rest for the pregnant women seems to contribute to an improved outcome of these gestations.

Birth Weight↗
PubMed1979

Towards a normalization of the outcome of twin pregnancy.

During 1973/1978, more than 90% of the pregnant women in Malmö, Sweden, were examined by ultrasound to improve the early diagnosis of twin pregnancy. This screening programme detected 90% of the twin pregnancies delivered during this period, 105 were subjected to a preventive treatment with bed rest in hospital, usually from the 29th to the 37th week (mean: 55 days). This study evaluates the outcome of these pregnancies, compared with those not treated with bed rest and with all twin pairs born a decade earlier (1963/1965). All twins of this group born up to 1 May 1977 were also monitored by regular postpartum check-ups until at least 18 months of age. Perinatal mortality was reduced to 0.5% in the group with bed rest, but remained as high (8%) as ten years earlier in the group without bed rest. The bed rest group, compared with the group without bed rest and the group of twins born 1963/1965, also showed a significantly reduced frequency of deliveries before the 37th week; also, the incidence of twins born light-for-gestational age and with birth weight below 1500 g was reduced. The incidence of twins born with cerebral palsy, mental retardation, and late development was 3% in 1973/1977 and 8.1% in 1963/1965. The reduction of mortality and morbidity of twins paralleled the improved obstetric and neonatal care. The fact that perinatal mortality and preterm delivery were reduced only among twins subjected to special antenatal supervision suggests that large gains are to be made by early detection and antenatal hospitalization. The lower CNS morbidity provides evidence of the quality improvement among the twin survivers.

Bed Rest↗
PubMed1978

Intrauterine growth of twins judged by BPD measurements.

Both earlier growth charts of twins composed of birth weight at different gestational ages and recent reports on twin biparietal diameter (BPD) growth, indicate that twins' growth is less than that of singletons during the later period of gestation. In the present study, growth curves are constructed separately for the first and the second twin from 489 paired ultrasonic BPD measurements of 119 twin pregnancies. The distribution of BPD values in twins was found to be slightly wider than our normal range curve for singletons. The mean BPD values of twins were close to those of singletons in the second trimester. From the 32nd week on, the twins' mean weekly BPD increment decreased, this lesser growth rate being more marked than that of singletons. The second twin's BPD growth curve ran consistently below that of the first. Our results agree with the earlier findings that the growth of twins is retarded during the later part of pregnancy. They point to different BPD growth patterns between the first and the second twin.

Birth Weight↗
PubMed1978

Monitoring of fetuses with retarded BPD growth.

Retarded BPD growth (less than 5th centile) is associated with low birth weight, preterm delivery, and increased perinatal mortality. However, 50% of the fetuses with deviating BPD growth in the 32nd week have normal weight at birth. In this study other biochemical and physical tests were applied to a group of fetuses with deviating BPD growth in order to improve the discriminatory rate between infants subsequently born AGA or SGA. Measurements of the ratio abdomen to head diameter were above the 50th centile in 72% of the infants born AGA and below the 50th centile in 75% of those born SGA. Circumference measurements were less useful in our hands. Urinary oestriol levels were not directly proportional to the intrauterine growth retardation. Recording of fetal breathing movements and nonstressed monitoring of fetal heart rate FHR) had little or no predictive value in the individual case although the incidence of fetal breathing movements was significantly lower in the group with retarded BPD growth.

Abdomen↗
PubMed1976

Ultrasound and human-placental-lactogen screening early detection of twin pregnancies.

In the past five years gradual introduction of ultrasonic screening of pregnant women increased the ante-partum detection of multiple pregnancy from 60% in 1971 to 95% in the first half of 1975. At the same time the average gestational age for dection of multiple pregnancies diminished from thirty-three to twenty-five weeks. The corresponding figures for 1963 were 32% and thirty-six weeks. Plasma human-placental-lactogen concentrations were assessed for their value in selecting a smaller target group for subsequent ultrasonic screening. All but 2 of 39 twin pregnancies examined by single H.P.L. determinations had H.P.L. values more than 1 S.D. above the mean of the normal distribution. The use of plasma-H.P.L. screening might lower the proportion of patients requiring ultrasonography for antepartum diagnosis of multiple pregnancies to 16% of the total pregnant population.

Evaluation Studies as Topic↗